Delaware
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68-0533453
|
|
(State or other jurisdiction of
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(I.R.S. Employer Identification No.)
|
|
incorporation or organization)
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||
12988 Valley View Road
|
||
Eden Prairie, Minnesota
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55344
|
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(Address of Principal Executive Offices)
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(Zip Code)
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CHF Solutions, Inc. 2017 Equity Incentive Plan
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CHF Solutions, Inc. 2013 Non-Employee Directors’ Equity Incentive Plan
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CHF Solutions, Inc. New-Hire Equity Incentive Plan
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(Full title of the plan)
|
John L. Erb
Chief Executive Officer
CHF Solutions, Inc.
12988 Valley View Road
Eden Prairie, MN 55344
(952) 345-4200
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||
(Name, address and telephone number, including area code, of agent for service)
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Phillip D. Torrence, Esq.
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Thomas P. Lynch
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Honigman LLP
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Chief Legal and Compliance Officer
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650 Trade Center Way, Ste 200
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CHF Solutions, Inc.
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Kalamazoo, MI 49002
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12988 Valley View Road
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(269) 337-7700
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Eden Prairie, MN 55344
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(952) 345-4200
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CALCULATION OF REGISTRATION FEE | ||||
Title of securities to be registered
|
Amount to be
Registered (1)
|
Proposed maximum
offering price
per share (2)
|
Proposed maximum
aggregate offering
price (2)
|
Amount of
registration
fee
|
Common Stock, par value $0.0001 per share
|
1,789,679
|
$0.39975
|
$715,424.18
|
$92.86
|
(1)
|
Pursuant to Rule 416(a) under the Securities Act of 1933, as amended (the “Securities Act”), this Registration Statement shall also cover any additional shares of the Registrant’s common stock (“Common Stock”) that become issuable under the
Plans (as defined below) by reason of any stock dividend, stock split, recapitalization or any other similar transaction without receipt of consideration that results in an increase in the number of shares of the Registrant’s outstanding Common
Stock.
|
(2)
|
Estimated solely for the purpose of calculating the registration fee pursuant to paragraphs (c) and (h) of Rule 457 under the Securities Act. The
offering price per share and aggregate offering price are based upon the average of the high and low prices of the Common Stock as reported on the NASDAQ Capital Market on May 11, 2020, a date within five business days prior to the date of
filing of this Registration Statement, for: (i) shares reserved for grant pursuant to the Registrant’s 2017 Equity Incentive Plan (the “2017 EIP”); (ii) shares reserved for grant
pursuant to the Registrant’s 2013 Non-Employee Directors’ Equity Incentive Plan (the “Directors’ EIP”); and (iii) shares reserved for grant pursuant to the Registrant’s New-Hire
Equity Incentive Plan (the “New-Hire Plan”; and collectively, with the 2017 EIP and the Directors’ EIP, the “Plans”).
|
Securities
|
Number of Shares
|
Offering Price
Per Share
|
Aggregate Offering Price
|
||||||||||
Shares reserved for grant under the 2017 EIP
|
1,468,350
|
(3)
|
|
0.39975
|
$
|
586,972.91
|
|||||||
Shares reserved for grant under the Directors’ EIP
|
251,329
|
(4)
|
|
0.39975
|
$
|
100,468.77
|
|||||||
Shares reserved for grant under the New-Hire Plan
|
70,000
|
(5)
|
|
0.39975
|
$
|
27,982.50
|
|||||||
Proposed Maximum Offering Price
|
|
715,424.18
|
(3)
|
Consists of shares that were automatically added to the shares authorized for issuance under the 2017 EIP on January 1, 2020 pursuant to an
“evergreen” provision contained in the 2017 EIP. Pursuant to the 2017 EIP, the share reserve will automatically increase on January 1st of each year, for a period of not more than ten years, commencing on January 1, 2018 and ending on (and
including) January 1, 2027, to an amount equal to thirteen percent (13%) of the fully diluted shares outstanding on December 31st of the preceding calendar year; provided that the Board of Directors may act prior to January 1st of a given year
to provide that there will be no January 1st increase in the share reserve for such year or that the increase in the share reserve for such year will be a lesser number of shares than would otherwise occur.
|
(4)
|
Consists of shares that were automatically added to the shares authorized for issuance under the Directors’ EIP on January 1, 2020 pursuant to an
“evergreen” provision contained in the Directors’ EIP. Pursuant to the Directors’ EIP, the share reserve will automatically increase on January 1st of each year, for a period of not more than ten years, commencing on January 1, 2014 and ending
on (and including) January 1, 2023, by an amount equal to two percent (2%) of the fully diluted shares outstanding on December 31st of the preceding calendar year; provided that the Board of Directors may act prior to January 1st of a given
year to provide that there will be no January 1st increase in the share reserve for such year or that the increase in the share reserve for such year will be a lesser number of shares than would otherwise occur.
|
(5)
|
Consists of shares reserved for grant under the New-Hire Plan pursuant to a Seventh Amendment to the New-Hire Plan that was approved by the
Registrant’s Board of Directors on December 5, 2019.
|
Incorporated By Reference
|
||||||||||||
Exhibit
Number
|
Exhibit
Description
|
Form
|
File
Number
|
Date of First
Filing
|
Exhibit
Number
|
Filed
Herewith
|
||||||
4.1
|
10
|
001-35312
|
February 1, 2012
|
3.1
|
||||||||
4.2
|
8-K
|
001-35312
|
January 13, 2017
|
3.1
|
||||||||
4.3
|
8-K
|
001-35312
|
May 23, 2017
|
3.1
|
||||||||
4.4
|
8-K
|
001-35312
|
October 12, 2017
|
3.1
|
||||||||
4.5
|
8-K
|
001-35312
|
January 2, 2019
|
3.1
|
||||||||
4.6
|
8-K
|
001-35312
|
May 23, 2017
|
3.2
|
||||||||
4.7
|
8-K
|
001-35312
|
June 14, 2013
|
3.1
|
||||||||
4.8
|
S-1/A
|
333-221010
|
November 17, 2017
|
3.7
|
||||||||
4.10
|
8-K
|
001-35312
|
January 29, 2020
|
3.1
|
||||||||
4.11
|
8-K
|
001-35312
|
August 8, 2016
|
4.1
|
||||||||
5.1
|
|
X |
||||||||||
23.1
|
|
X |
23.2
|
Consent of Honigman LLP
|
|
Included in Exhibit 5.1
|
|||
24
|
Power of Attorney (included on signature page)
|
|
X |
|||
99.1
|
14A
|
001-35312
|
April 5, 2013
|
App. A
|
||
99.4
|
10-Q
|
001-35312
|
August 8, 2013
|
10.1
|
||
99.5
|
10-Q
|
001-35312
|
November 12, 2013
|
10.1
|
||
99.6
|
S-8
|
333-202904
|
March 20, 2015
|
99.12
|
||
99.7
|
S-8
|
333-210215
|
March 15, 2016
|
99.13
|
||
99.8
|
8-K
|
001-35312
|
May 30, 2017
|
10.4
|
||
99.9
|
8-K
|
001-35312
|
January 18, 2018
|
10.1
|
||
99.10
|
10-Q
|
001-35312
|
August 8, 2019
|
10.2
|
||
99.11
|
8-K
|
001-35312
|
December 6, 2019
|
10.1
|
||
99.13
|
8-K
|
001-35312
|
May 30, 2017
|
10.1
|
† |
Indicates management compensatory plan, contract or arrangement.
|
CHF SOLUTIONS, INC.
|
||
By:
|
/s/ John L. Erb
|
|
Name:
|
John L. Erb
|
|
Title:
|
Chief Executive Officer
|
SIGNATURE
|
TITLE
|
DATE
|
/s/ John L. Erb
|
President, CEO and Chairman
|
May 14, 2020
|
John L. Erb
|
(principal executive officer)
|
|
/s/ Claudia Drayton
|
Chief Financial Officer
|
May 14, 2020
|
Claudia Drayton
|
(principal financial and accounting officer)
|
|
/s/ Steve Brandt
|
Director
|
May 14, 2020
|
Steve Brandt
|
||
/s/ Maria Rosa Costanzo
|
Director
|
May 14, 2020
|
Maria Rosa Costanzo
|
||
/s/ Jon W. Salveson
|
Director
|
May 14, 2020
|
Jon W. Salveson
|
||
/s/ Gregory D. Waller
|
Director
|
May 14, 2020
|
Gregory D. Waller
|
||
/s/ Warren S. Watson
|
Director
|
May 14, 2020
|
Warren S. Watson
|
||
HONIGMAN
Honigman LLP
Attorneys and Counselors
|
(269) 337-7700
Fax: (269) 337-7701
|
Very truly yours,
|
|
/s/ Honigman LLP
|
/s/ BAKER TILLY VIRCHOW KRAUSE, LLP
|
|
Minneapolis, Minnesota
|